CLEVELAND, Ohio - From a mid-sized nursing home in Northwest Ohio, Joe Jolliff became a national leader in worker safety.

Jolliff served as the administrator at the Wyandot County Home, later known as the Wyandot County Skilled Nursing and Rehabilitation Center, from 1982 through 2003. His initiatives to address staff injuries drastically reduced worker compensation claims and turnover. He modernized the 100-bed nursing home, relying on technology to lift and move residents.

The tools he employed increased the safety of the staff and the quality of care for residents. He crisscrossed the country, urging administrators as far away as California to empathize with their staffs by embracing technology.

Joe Jolliff

"We expected nurse's aides to lift people,'' said Jolliff, who lives in Florida and is retired. "That's just not right. Our bodies can't do that repeatedly.''

To reduce injuries, advocates for nursing home residents say more must be done to make the job safer for nursing assistants and nurses. They have urged administrators to spend more money on lifts and on training.

They point to Jolliff's work as an example.

Frustrated after two aides got hurt in the mid-1990s, Jolliff decided to spend about $116,000 of the Wyandot nursing home's funds to install pieces of various equipment, including ceiling lifts. The lifts can move residents who need help transitioning from beds to wheelchairs or to the bathroom, without the physical strain on the nursing assistants.

He also purchased electric beds, which allowed staff to easily raise and lower the height for easier access to wash and turn residents.

The equipment had an immediate impact. In the mid-1990s, the Wyandot facility was paying an average of $140,000 a year in workers' compensation claims, according to the Ohio Bureau of Workers' Compensation.

After spending money on the equipment, the nursing home paid out an average of $4,000 a year in workers' compensation claims in the early 2000s.

"It was the right thing to do,'' Jolliff said.

Administrators now at the nursing home said they continue to use lifting mechanisms to reduce the physical strain on staff.

In 2009, the U.S. Occupational Safety and Health Administration had notified the 99-bed nursing home of the number of its employees who had been off the job because of injury.

Specifically, the federal agency measured something known as the DART rate, or the average number of worker days away, restricted or transferred because of injury. The nursing home said its rate was 4.51 per 100 employees in 2009. That was approaching the national average for nursing homes, 5.6 at that time, according to published reports.

Trinity volunteered to work with an OSHA program designed to reduce injuries. Among the changes, the facility implemented a no-lift policy, which stresses the use of mechanical devices, such as lifts to move residents and chairs that help residents stand easily; pushed greater training; and mandated employees to wear non-skid shoes.

Through it all, employees had a say in the training and the nursing home's safety policies.

In 2016, the nursing home's DART rate was 2.05, well below the national average rate of 4.2 that year.

"We didn't wait for people to get injured; we realized where there was the greatest potential for hazards, and we kind of went after it from there,'' said Keith Bullock, a consultant for OSHA's Onsite Consultation Program.

Kathleen Wojcehowicz, a registered nurse and Trinity's safety manager, said she has worked in nursing homes since the 1960s. She has seen how the shift in training and the use of lifts have helped nurse's aides and nurses.

"From 1967 to 1971, there were no safety precautions,'' she said. "You had no lifts. You had nothing. I mean, you just lifted people up from under their arms and hoped for the best.''

Investing in safety

Studies have shown that nursing homes that invest in worker safety recover the money in savings on workers' compensation claims.

In 2004, the National Institute for Occupational Safety and Health published a study in which an unidentified nursing home spent $158,566 for lifting equipment and worker training. The initial investment was recovered in three years, as it saved more than $55,000 a year in workers' compensation costs.

Some area nursing homes have seen the benefits that resulted in more than savings. One is Jennings, a care facility with more than 100 beds in Garfield Heights.

It adds 10 ceiling lifts a year, which cost about $10,000 per lift, said Susan LoDolce, the director of nursing services. The equipment has helped attract and retain talent.

When young nursing assistants or nursing students from area colleges visit, they are struck by the devices. They often say, "Oh, you have the equipment right there in the room,'' said Rachele Rosa, the facility's chief healthcare administrator.

The statewide turnover rate in Ohio for nursing assistants was 54 percent in 2015, said John Bowblis of the Scripps Gerontology Center at Miami University. The 2015 information was the most recent data available.

Jennings says its turnover rate is significantly lower than the statewide average. "It's more like 25 percent," said Denise Smudla, Jennings' director of human resources.'

Jennings said one way it has lowered its turnover rate has been to encourage job advancement among its staff, providing tuition assistance and flexible schedules.

The care center collaborated with researchers from Kent State in 2006. An equipment upgrade, which included ceiling lifts and beds that could be raised and lowered quickly, was partially funded during that study.

After learning about that collaboration, professors in the engineering school and the health sciences department at Cleveland State University approached the facility. They asked the care center if it wanted to participate in a study that used smart watches and a tracking system to alert nursing assistants if they bend improperly while caring for a resident.

The technology is part of the researchers' study to reduce lower back injuries among nursing assistants, said Wenbing Zhao, a Cleveland State engineering professor.

Peter Van Runkle is the executive director of the Ohio Health Care Association, which represents for-profit and nonprofit nursing homes. He said his agency has pushed worker safety for years, and many care centers have policies on the handling of residents.

Van Runkle's agency and others are quick to point out that the Ohio Bureau of Workers' Compensation, for instance, offers safety grants that will pay $3 for every $1 a business invests, up to $40,000.

He said Jolliff urged other nursing homes to take advantage of government safety grants.

"I would consider him to be a pioneer,'' Van Runkle said. "He was good at getting money from the BWC for equipment. He was passionate and vocal. It was a model facility. I don't know if he was the only person doing this or if there were more, but he was the most visible.''

Missing the big picture

Advocates for residents said the push for safety in nursing homes has increased in recent years, yet much more needs to be done. They question why more nursing homes have not made the investment.

They said that while some nursing homes are filled with the equipment, there are many others that lack more than two or three lifts.

"A lot of nursing homes, not all, of course, but many, look at a short-term bottom line,'' said Richard Mollot, the executive director of the Long-Term Care Community Coalition in New York City, which monitors nursing home care. "They care only about what's going to happen in the short-term. They don't have a longer view for residents, their staff and their business.''

By contrast, Jolliff sought to place ceiling lifts in as many rooms as possible to help immobile residents.

"I could take a 500-pound person to the bathroom with two fingers,'' Jolliff said. "If you expect people to work without equipment, it's a dangerous job. But it doesn't have to be that way.''